'Complete freedom from disease and from struggle is almost incompatible with the process of living, ' Rene Dubos asserted in this classic essay on ecology and health. All the accomplishments of science and technology, he argued, will not bring the utopian dream of universal well-being, because they ignore the dynamic process of adaptation to a constantly changing environment that every living organism must face.

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'Complete freedom from disease and from struggle is almost incompatible with the process of living, ' Rene Dubos asserted in this classic essay on ecology and health. All the accomplishments of science and technology, he argued, will not bring the utopian dream of universal well-being, because they ignore the dynamic process of adaptation to a constantly changing environment that every living organism must face.

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'Complete freedom from disease and from struggle is almost incompatible with the process of living, ' Rene Dubos asserted in this classic essay on ecology and health. All the accomplishments of science and technology, he argued, will not bring the utopian dream of universal well-being, because they ignore the dynamic process of adaptation to a constantly changing environment that every living organism must face.

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Matthew Theisen

5,0 de 5 estrellasInformation Packed Yet Very Engaging

8 de diciembre de 2011 - Publicado en Amazon.com

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I wish I knew of more books like Mirage of Health. Written by a scientist--Dubos was a Harvard-trained Microbiologist--it is not by any means an academic work. It doesn't make use of footnotes or even a bibliography. We are left to trust in Dubos' authority as scientist and author which I had no problem doing.

Despite being written in 1959, the book is surprisingly fresh and almost timeless. This is mostly because Dubos writes primarily about events and trends that occurred in the decades and centuries before it was written and doesn't spend a long time focusing on the contemporary state of medical science. One interesting exception to this is when Dubos mentions that cancer's cause--which is now known to be genetic mutation--was unknown at the time of writing.

Dubos makes it clear that the doctrine of specific etiology (that is the notion that all medical problems can be traced to a certain, physical cause) has contributed more to medicine in the last century than probably any other idea. Yet Dubos also stresses the limitations of this mindset. He emphasizes that with physical ailments, there are many causes at work and it is difficult or impossible to determine the most significant among these. By emphasizing the multitude of factors that determine our health, Dubos makes it clear that balance with our environment is of utmost importance to maintenance of health.

Dubos illustrates this point historically in a most vivid fashion. In the presence of a new pathogen, for example, a population can be decimated. Dubos uses the example of the introduction of smallpox to America as an example of such devastation. Another way that Dubos illustrates humans' relationship with their environment is the story of a Zulu tribe in Africa. Traditionally, this tribe had grown millet as a staple. The British introduced corn which was easier to cultivate. However, unbeknownst to either group, corn lacked some key nutritional particles which millet had provided. As a result of the widespread adoption of corn, the tribe was left much more disease-prone.

One way that Dubos humbles the physician's profession is his use of historical disease rates for tuberculosis, typhus, scarlet fever and other infectious episodes. These infections subsided before effective treatments were known or used. Rather, these diseases were controlled through social efforts at providing populations with 'clean air, clean water, clean food'. Not driven by any scientific ideology (the germ theory hadn't been widely accepted), the social reformers of England and France in the mid- and late-nineteenth-century were nonetheless successful at reducing infection and death from many infectious diseases.

Mirage of Health is a book of incredible balance, written with a scientist's mind and a philosopher's pen. It is a refreshingly lyrical and engaging vehicle for scientific ideas. I hadn't been exposed to microbiology in such an interesting way prior to reading this book and if I'd read this book earlier perhaps I would've enrolled in microbiology courses as a college student. For those who already know what Dubos is trying to tell us, the book might not hold the same charm, but for anyone interested in microbiology, epidemics and the social history of disease, this book is a treasure.

I'm so grateful to have happened upon this work. It could stand to be edited a bit - it gets very repetitive and almost circular - but the first couple of chapters are strong, brilliant, enlightening. Two achievements stand out:

1) Dubos has some of the best illustrations of the cyclic/repetitive nature of social thought. He offers a very clear interpretation of meta-medicine since the early Greeks in the Western world, with some decent insights about non-Western cultures as well. (Remember that this book was written in 1959; here's some salt, take a grain of it.)

2) He has a great overall critique of our philosophy of causation in the medical sciences, with a specific focus on the relation between microbial parasites and disease. We know that bronchitis, for example, is caused by certain bacilli, but we also discover that, killing off those bacilli, the patient won't necessarily get better; another infection can take hold. Conversely, and I didn't realize this before reading Mirage of Health, essentially every European urbanite in the 19th century was infected with tuberculosis - but only "were consumptive", became ill. He points out that obliterating bacterial competition is neither possible, desirable, nor necessary, which is on the one hand, so very interesting in its ivory tower way, and on the other hand, so very important. Drug-resistant TB is worsening the world over, from Russia to South Africa to Haiti, and the only thing that consistently works are comprehensive programs that don't just drug the patient, don't just treat the whole patient, but treat the community and environment as a whole. I'm not really interested in being alarmist - "we'll find ourselves in a whole heap of trouble if we don't listen!! zomg" - but the possibility to prevent human suffering is enormous.